Stress urinary incontinence surgery trends in academic female pelvic medicine and reconstructive surgery urology practice in the setting of the food and drug administration public health notifications

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/136665/1/nau23080.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136665/2/nau23080_am.pd

Sexual Health in Adult Men with Spina Bifida

Medical and surgical advances in the treatment of spina bifida (SB) have resulted in increasing numbers of patients reaching adulthood. As such, issues related to sexual maturity are being investigated to offer optimal healthcare to men with spina bifida. This report constitutes a review of the current literature relating to adults with spina bifida and issues of sexuality, erectile dysfunction and fertility. In general, adult males with spina bifida have normal sexual desires and an interest in addressing these issues with healthcare providers. Sexual education and access to intimacy are delayed compared to the general population. 75% of men achieve erections, but maintaining erections is a problem and some may be merely reflexive in nature. The many of these men show marked improvement with sildenafil. In SB erectile dysfunction and infertility are related to the level of neurological lesion with the best performance status in those with sacral lesions and intact reflexes. Men with lesions higher than T10 are at risk for azoospermia. There is an increased risk of neural tube defects in the children of men with spina bifida, but the current incidence with modern folic acid therapy is unknown. As the number of males with spina bifida reaching sexual maturity increases, further investigation into sexuality, sex education, intimacy, and treatments for erectile dysfunction and infertility will be needed

Avaliação e tratamento da bexiga hiperativa

The overactive bladder is characterized by symptoms of frequency, urgency, and urge incontinence, substantially affecting the quality of life of millions of people throughout the world. The symptoms are associated with significant social, psychological, occupational, domestic, physical, and sexual problems. Despite the considerable impact of this condition on quality of life, sufferers are often unwilling to discuss their problem with family members or health care professionals. This situation is unfortunate, for much can be done to alleviate the symptoms of this distressing condition. It is therefore of utmost importance that medical education about symptoms of the overactive bladder and other related problems be improved to help health care professionals identify and treat patients who will benefit from therapy. This article reviews current thinking regarding definition, epidemiology, quality of life effects, evaluation, and management of the overactive bladder.A bexiga hiperativa é caracterizada pelos sintomas de freqüência, urgência e urge-incontinência e afeta de forma significativa o estilo de vida de milhões de pessoas em todo o mundo. Os sintomas são responsáveis por problemas nas esferas social, psicológica, ocupacional, doméstica, física e sexual dos pacientes. Apesar do considerável impacto desta condição sobre a qualidade de vida, grande parte dos pacientes reluta em discutir o problema com membros da família ou profissionais de saúde. Esta situação é lamentável, já que existem muitas maneiras de aliviar os sintomas da hiperatividade vesical. Por essa razão, é fundamental que se aprimore a educação médica sobre os sintomas de hiperatividade vesical e outros problemas relacionados, de modo a preparar os profissionais de saúde a identificar e tratar os pacientes com esta condição. Este artigo é uma revisão dos conceitos atuais, definição, epidemiologia, efeitos sobre a qualidade de vida, avaliação e tratamento da bexiga hiperativa

Severe urinary tract damage secondary to primary bladder neck obstruction in women.

ObjectiveTo present the clinical and radiological characteristics of women with severe structural deterioration of the bladder and upper urinary tract secondary to Primary Bladder Neck Obstruction (PBNO), and their outcomes after bladder neck incision (BNI).MethodsRetrospective evaluation of adult women who underwent BNI for PBNO at one institution. Patients were assessed for symptoms, renal function, structural abnormalities of the urinary tract and video-urodynamics. PBNO diagnosis was confirmed with video-urodynamics in all patients. BNI was performed at the 4-5 and/or 7-8 o'clock positions. Postoperative symptoms, PVR, uroflowmetry and renal function were evaluated and compared to baseline.ResultsMedian patient age was 56.5 years (range 40-80). All presented with urinary retention-four were on clean intermittent Catheterization (CIC) and two with a Foley catheter. All patients had bladder wall thickening and diverticula. Four women had elevated creatinine levels, bilateral hydronephrosis was present in five (83.3%). After BNI, all patients resumed spontaneous voiding without the need for CIC. Median Qmax significantly improved from 2.0 [1.0-4.0] mL/s to 15 [10-22.7] mL/s (p = 0.031). Median PVR decreased from 150 to 46 [22-76] mL (p = 0.031). There were no postoperative complications. Creatinine levels returned to normal in 3/4 (75%) patients.ConclusionPBNO in women may result in severe damage to the bladder and upper urinary tract. Despite severe structural abnormalities of the bladder, BNI was effective in reducing symptoms and improving structural and functional abnormalities of the lower and upper urinary tract